This 29-years old lady had a chest radiograph for cough and fever. It showed an expansile lesion of the right posterior 5th rib (Fig. 1). This pattern typically occurs with either fibrous dysplasia or enchondroma, though the commonest entity in an asymptomatic individual is fibrous dysplasia (1).
Nevertheless a CT scan was performed. Thick maximum intensity projection (MIP) axial (Fig. 2a) and coronal (Fig. 2b) images show an expansile osteolytic lesion with thickening of the cortical margins at places along with a subtle ground-glass matrix. This again is typical of fibrous dysplasia.
The Flattened/Unfolded Rib image (Fig. 4) reconstructed on the new Syngo Via platform (2, 3) with automatic numbering of the ribs shows this lesion extremely well.
Since the patient and orthopedic surgeon were still concerned about the diagnosis, a CT guided biopsy (Fig. 4) was performed that confirmed the presence of a fibro-osseous lesion.
Because of the curvature of the rib, it can be difficult to visualize rib lesions, especially subtle fracture on routing reading, even with multiplanar reconstructions (MPRs) and MIPs. The new Siemens Syngo Via has a Bone Reading module that automatically flattens out the ribs and spine and allows quick and accurate evaluation of rib pathology, both fractures (3) and tumors (4,5).